Robot-Assisted Versus Conventional Laparoscopic Antireflux Surgery: A Retrospective Cohort Analysis of Perioperative and Medium-Term Outcomes

Gastroesophageal reflux disease (GERD), often associated with hiatal hernia (HH), is commonly treated with conventional laparoscopic anti-reflux surgery (CLAS). Robotic-assisted anti-reflux surgery (RAAS) is emerging as an alternative with enhanced precision and ergonomics. This study compares perioperative outcomes and mid-term symptom resolution between RAAS and CLAS. A retrospective cohort study included 91 patients (RAAS: n = 31, CLAS: n = 60) undergoing primary anti-reflux surgery from April 2022 to April 2024. Inclusion criteria included confirmed GERD and inadequate proton pump inhibitor response. Surgical steps were standardized, and perioperative metrics (operative time, complications, hospital stay) and 12-month symptom outcomes were compared. RAAS and CLAS had comparable demographics and comorbidities (P > 0.05). RAAS had a longer total operative time (158.8 ± 21.8 vs. 146.4 ± 23.8 minutes, P = 0.02), mainly due to a longer retroesophageal tunnel establishment (P < 0.01). RAAS showed superior symptom resolution (80.6% vs. 56.7%, P = 0.02) without differences in intraoperative complications, reoperations, or hospital stay. Docking time decreased with experience (P < 0.01), reflecting a learning curve. RAAS provides comparable safety and postoperative outcomes to CLAS but achieves higher symptom resolution (80.6% vs. 56.7%, P = 0.02). While operative times are longer for RAAS, this difference is limited to initial steps. RAAS demonstrates technical feasibility with a learning curve, suggesting it may improve precision in anti-reflux surgery. Further studies are needed to assess its long-term efficacy.